The present apparatus and method are directed to a means and procedure for dispensing medications as typically occurs in nurse rounds in a large hospital. In a typical situation, many patients, located in individual rooms, large wards or both, are deployed at or near a nurse station. Every morning and at other times during the day required nursing personnel begin medication rounds at which time a cart loaded with appropriate medications is pushed down the hallway from patient to patient (in rooms or wards) and individual medications are administered. Each round of the medication cart requires a rather complicated procedure. Individual orders for the various patients from a multitude of treating physicians must be examined and the cart loaded with the medications in advance. At the time of making the medication round, individual patient chart orders must be then reviewed at the cart so that prescribed medicine can be administered to each patient. A patient may receive more than one medication with each round, and the dispensing of such medications must be recorded with suitable verification to assure that the orders have been carried out. This typically involves multiple pieces of paper, one for the order from the treating physician, dispensing of that particular medication and written verification that it has been given to the patient. This is accomplished for every medication that is required, including those that are optional such as open orders where medication is prescribed on an "as needed" basis, meaning that the patient may or may not get that medication depending on their particular symptoms as dynamically determined. The foregoing is a tedious procedure and involves generation of substantial paperwork including written verification that the medications have been given which must be subsequently mounted in the patient's medical record. The nurse station normally collects individual medical records for each patient. The records can accumulate over a period of time, and, for someone who has been ill for some period of time, the record can become quite large. For people who have been hospitalized for weeks or months, their bound medical records can weigh many pounds.
The foregoing procedure is relatively complex, but an even more complex procedure is involved in the dispensing of narcotics. By definition, they are medications subject to prescription dispensing only. However, because they are viewed as inherently dangerous and are regulated by various Federal or State agencies, an extra sequence of steps is required in dispensing narcotics. The medical cart does not leave the floor. For medications other than narcotics an interchangeable rack of drawers is brought to the floor by pharmacy personnel. Narcotics are brought to the nursing station on the floor by specifically designated personnel. Prior narcotic inventory sheets with amount of drugs given in 24 hours and amount remaining are picked up by the pharmacy personnel once per day, usually at an early hour. The sheets are carried to the pharmacy to determine what stock to send by designated personnel who later deliver the narcotics and stock the cart. This person has responsibility for narcotics from the central pharmacy. The nurse accepts responsibility for the drugs when they arrive on the floor. In an alternate reloading process, the medication cart must be removed from the floor to be charged at the hospital pharmacy with its needed narcotics. At the pharmacy, the narcotics (in a locked vault or safe) are loaded onto the medicine cart. In turn, the medicine cart must be a locked vehicle where the narcotics are kept in a secure fashion. The narcotics are thus kept under lock and key arrangement where the key is checked out by a particular person who removes the cart after the cart has been loaded.
The cart must typically be charged with a specific number of narcotic medications. It is not uncommon to place 20-30 different types of narcotics in a cart, and the number of doses for each particular narcotic can be as high as 50. The cart is thus loaded with the requisite number of doses of the various narcotics and an inventory is then established. The inventory at the time the cart is loaded with narcotics is compared with the ending inventory minus the deletions which are administered to the various patients during nurse rounds. This added layer of paperwork creates significant delays in administering the medicines and narcotics. In addition, however, each patient receiving narcotics is provided with a written record at the time of dispensing so that the written record can later be incorporated in the patient's chart. Again, this represents the generation of an additional document which must be removed from the cart and integrated into the chart for that particular patient. On a large hospital floor with substantial patient census, the stacks of paperwork accumulated after a round of dispensing medications (including narcotics) is voluminous. It requires detailed record keeping at each step of the way. All of this clerical work basically detracts from quality attention to the patients; the nursing personnel must pay more attention to keeping the paperwork than to the patients. These are also problems with the human recorder, errors require time to resolve or remain unresolved.
The present invention is a method and apparatus for overcoming these problems. It defines a medication cart which is equipped with an onboard computer system having suitable input devices such as a card reader, keyboard, and bar reader. The cabinet of the cart is divided into two portions, one being a conventional cabinet and the other portion constructed for enclosing narcotics. That portion is closed with a locked door, and includes means for dispensing narcotics only when prompted. The narcotics dispensing means has the improved form of a type of vending machine which delivers the order from the supply while storing the supply safely in the cabinet. Particular details of the present apparatus should be noted. Narcotics are stored in a locked cabinet. A large door covers over the locked cabinet. In addition, individual narcotics can be locked in individual compartments with their separate lock and key arrangement for each individual type of narcotic medication. It is not uncommon to load as many as 40 different types of narcotic medications onto a cart, each being provided with one or more units of dosage. For more popular narcotics, the total dosage may be perhaps 50 individual doses. For such popular narcotics, one approach is to load individual carpules into a holder and dispense single units so that the carpules slide out through a slot, administered in the fashion of a vending machine. The narcotic dispensing mechanism cooperates with the packaged form of narcotics, i.e. carpule or individual packets comprising a support card with a bubble or blister pack over an individual pill, tablet or capsule, and they are dispensed from the recesses of cabinetry so that only one dose is exposed at an interval.
Beginning and ending narcotics inventory is much more readily accomplished. For instance, narcotics which are stored within the cabinetry and which are dispensed one unit at a time are never exposed. If 20 units were initially loaded, the number actually dispensed is measured in memory and the ending inventory for that particular medication is then calculated. Furthermore, the apparatus sustains an inventory at all points of dispensing along the nurse rounds. When the round has only been partly finished, a precise count is known even then so that inventory aboard the cart can be measured. In sum, narcotics inventory is obtained at all times, from the beginning inventory stored in the cart, to the last inventory. Moreover, painstaking hand counts or verification thereof can be avoided. The present invention is, therefore an apparatus implementing a method of operation whereby nurse rounds for dispensing medication (and especially including narcotics) are expedited. This is accomplished by providing a CRT or alternatively a printer on the cart which provides a continuing output of patient medications in a particular sequence. The sequence can be organized so that rounds proceed in the best sequence, beginning perhaps with the closest patient room to the nurse station and ending at the farthest or in some other sequence so that travel of the cart is orderly, and where each stop adjacent a patient is sequential and the medications are prompted to the nursing personnel in sequence. This is achieved by collecting all the medication orders, inputting the orders, sorting the orders into that sequence, collecting inventory to conform with the orders, loading the cart with that inventory and then arranging the patients medications in a particular queue. All medications including narcotics can then be drawn from the cart and administered quicklY. Moreover, as each medication is administered the personnel in charge of medication can provide verification back to the cart mounted CPU and ultimately obtain printed verification. This document is available by patient for incorporation in the patient chart typically maintained at the nurse's station. Dispensing errors could be reduced decreasing possibility of patients overdosage and potential associated litigation. Another problem that could be reduced is last medication charges; medication given and not charted are an expense that must be absorbed by institutions.
The apparatus includes a wheel mounted cart with a number of cubicles for storing medication. It includes a locked door which is released only by inputting appropriate codes. Behind the door, various narcotics are stored. Several narcotics are stored in individual cubicles or alternatively, different types of dispensing mechanisms operating in the fashion of coin operated vending machines deliver the various narcotics. Thus, the narcotics can be locked behind a first door and individual narcotics can be locked again, the looks being opened or the narcotics dispensed in individual dosage by means of coded inputs. After a medicine has been removed from the cart, it is packaged in an individual package where a bar code reader (in the form of a wand) is used to read the code to make verification that the dispensed medicine removed from the cart is in fact the medicine specified in the order. For narcotics, it is desirable to provide an extra step, namely identification of the nursing personnel and for this purpose, a keyboard or card reader or both is used. Personnel are normally provided with a badge which can be read by the card reader; in the event the badge is lost, protection can be obtained by inputting a personal identification number (PIN hereafter). Cart theft and pilferage is prevented by incorporating an alarm system and a battery monitor which provides alarm signals to personnel.